MONTREAL – Physician-assisted dying (PAD) will likely never be accepted in Israel because of the sway of the religious political parties, but the Knesset did pass the country’s first end-of-life care law recently, and it managed to respect Halachah’s stringency on the sanctity of human life, even in terminal or hopeless cases, and society’s demand for compassionate care, said bioethicist Vardit Ravitsky.
Ravitsky, who sat on an experts committee that developed the legislation and is a bioethicist with the Université de Montréal’s department of social and preventive medicine, was a panelist in a discussion on Canada’s PAD law, C-14, held at the Reconstructionist Congregation Dorshei Emet on June 11.
Active euthanasia, such as a doctor’s administering a fatal injection to a consenting patient in a “grievous and irremediable” condition, in the words of the Canadian bill, was not considered in Israel, Ravitsky said.
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What some call passive euthanasia, or the withholding or withdrawing of treatment, is something the committee, which included Orthodox rabbis, wrestled with.
Specifically, the question of whether to put a gravely ill person on a respirator has been acutely difficult in Israel because once on, such patients are not disconnected even though it may prolong suffering, she said.
Typically, the decision to put a patient on a respirator has to be made quickly, and desperate families are often confused about what to do, Ravitsky said. Policies differ among hospitals and some cases have ended up in court, she added.
Knowing they could not have the respirator disconnected, anecdotal evidence suggests, families have refused to start the intervention even though that shortened the lives of their relatives, she said.
The rabbinate considers artificial respiration a “continuous treatment,” and therefore forbids its being stopped. Doctors do not want to do it.
By attaching a timer to the respirator, she said, there is a period, perhaps a week, to consider whether to renew the intervention or let nature take its course. In addition, this compromise relieves doctors from having to pull the plug, so to speak.
That the Israeli rabbinate has accepted this “ingenious solution,” in Ravitsky’s opinion, is quite a departure from its stance that there is no moral distinction between assisting someone to die and taking no action to prevent a death.
While Halachah speaks of the “infinite value” of human life to the last moment, no matter how poor its quality may seem, and prohibits hastening death, Ravitsky said it also forbids interfering with the “natural process of dying.”
The rabbinate agreed that when the period with the timer was up, it is permissible not to restart the respirator, she said. This is much the same attitude as it has to dialysis treatments, which are considered “discrete” and may not be resumed, according to Halachah, after a session.
The need for good, accessible palliative care is also stressed in the Israeli law, Ravitsky said, something fellow panelist Kappy Flanders said is lacking in Canada’s current debate.
Flanders, founder and co-chair of McGill University’s Council on Palliative Care and an activist in this area for more than 20 years, has no quarrel with PAD in cases when death is immediate and suffering is great.
However, she stressed that equal focus must be on the importance of palliative care in the current public conversation.
Canadian are left to believe that the only choice is PAD or being forced to go on living in intolerable pain or indignity, she said.
Palliative care should be an essential part of the continuum of care, and offered not only in the final days, but rather earlier in the course of an illness, Flanders believes.
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“Just as we support prenatal care, we have to be a society that nurtures the end of life. As a society, we must stop fearing death,” she said. Dying should be viewed as another, inevitable step in life’s journey, she added.
The problem is that 60 to 80 per cent of Canadians have no access to palliative care, or even know what it is, she pointed out. The council’s definition is care that “optimizes quality of life by anticipating, preventing and treating suffering.”
The panel discussion was sponsored by the congregation’s annual Ruth Richler Memorial Lecture. It also included a legal perspective on C-14 by Alana Klein, who teaches health law, criminal law and human rights in McGill’s law faculty, and a broader philosophical view by Natalie Stoljar, an associate professor in McGill’s department of philosophy and Institute of Health and Social Policy.